Claims Examiner

Job description

We are looking for a Claims Examiner, someone who’s ready to grow with our company. In this position, you will process and adjudicate claims received for reimbursement to Providers based on extensive review, research, and a detailed format of claim processing procedures. Think you’ve got what it takes? Job Duties & Responsibilities: - Adjudicate claims received into processing system. - Thoroughly reviews, investigates, and adjudicates claims daily, working oldest to newest claim in 30 days or less, and 98% of the time. - Examiners should process at least 14 claims per hour, or 98 claims per day. - Conducts review and investigation of pended claims and follow up with internal and external departments to finalize claims resolution within 30 days. - Macess requests are processed within 30 days of receipt, with a 98% accuracy, to ensure timely resolution of claims, in adherence with HHSC regulatory requirements. - The claims are processed accurately as defined by standard guidelines. - The claims should be adjudicated with a 98% procedural accuracy rate monthly as reviewed by weekly audit reports. - The claims should be adjudicated with a 98% accuracy rate monthly as reviewed by retur...